Center for Precision Medicine in Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
Transl Psychiatry. 2023 Feb 21;13(1):64. doi: 10.1038/s41398-022-02298-x.
Post-traumatic stress disorder (PTSD) is a mental disorder diagnosed by clinical interviews, self-report measures and neuropsychological testing. Traumatic brain injury (TBI) can have neuropsychiatric symptoms similar to PTSD. Diagnosing PTSD and TBI is challenging and more so for providers lacking specialized training facing time pressures in primary care and other general medical settings. Diagnosis relies heavily on patient self-report and patients frequently under-report or over-report their symptoms due to stigma or seeking compensation. We aimed to create objective diagnostic screening tests utilizing Clinical Laboratory Improvement Amendments (CLIA) blood tests available in most clinical settings. CLIA blood test results were ascertained in 475 male veterans with and without PTSD and TBI following warzone exposure in Iraq or Afghanistan. Using random forest (RF) methods, four classification models were derived to predict PTSD and TBI status. CLIA features were selected utilizing a stepwise forward variable selection RF procedure. The AUC, accuracy, sensitivity, and specificity were 0.730, 0.706, 0.659, and 0.715, respectively for differentiating PTSD and healthy controls (HC), 0.704, 0.677, 0.671, and 0.681 for TBI vs. HC, 0.739, 0.742, 0.635, and 0.766 for PTSD comorbid with TBI vs HC, and 0.726, 0.723, 0.636, and 0.747 for PTSD vs. TBI. Comorbid alcohol abuse, major depressive disorder, and BMI are not confounders in these RF models. Markers of glucose metabolism and inflammation are among the most significant CLIA features in our models. Routine CLIA blood tests have the potential for discriminating PTSD and TBI cases from healthy controls and from each other. These findings hold promise for the development of accessible and low-cost biomarker tests as screening measures for PTSD and TBI in primary care and specialty settings.
创伤后应激障碍（PTSD）是一种通过临床访谈、自我报告量表和神经心理学测试诊断的精神障碍。创伤性脑损伤（TBI）可能具有与 PTSD 相似的神经精神症状。对于缺乏专业培训、在初级保健和其他一般医疗环境中面临时间压力的提供者来说，诊断 PTSD 和 TBI 具有挑战性，而且更具挑战性。诊断主要依赖于患者的自我报告，由于耻辱感或寻求赔偿，患者经常少报或多报自己的症状。我们旨在利用大多数临床环境中都可用的临床实验室改进修正案（CLIA）血液检测来创建客观的诊断筛选测试。在伊拉克或阿富汗战区暴露后，对 475 名患有和未患有 PTSD 和 TBI 的男性退伍军人进行了 CLIA 血液检测结果确定。使用随机森林（RF）方法，从 PTSD 和 TBI 状态中得出了四个分类模型。使用逐步向前变量选择 RF 过程选择了 CLIA 特征。区分 PTSD 和健康对照者（HC）的 AUC、准确性、敏感性和特异性分别为 0.730、0.706、0.659 和 0.715，TBI 与 HC 相比为 0.704、0.677、0.671 和 0.681，PTSD 与 TBI 合并与 HC 相比为 0.739、0.742、0.635 和 0.766，PTSD 与 TBI 相比为 0.726、0.723、0.636 和 0.747。酒精滥用、重度抑郁症和 BMI 等共病不是这些 RF 模型中的混杂因素。葡萄糖代谢和炎症标志物是我们模型中最重要的 CLIA 特征之一。常规 CLIA 血液检测有可能将 PTSD 和 TBI 病例与健康对照者以及彼此区分开来。这些发现为在初级保健和专业环境中开发用于 PTSD 和 TBI 的易于获取和低成本生物标志物测试作为筛选措施提供了希望。
